MEDICARE: OHIO AUTISM TREATMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251S00000X	Community/Behavioral Health Agency
4	252Y00000X	Early Intervention Provider Agency
5	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124974597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO AUTISM TREATMENT LLC

Provider Business Mailing Address
First Line	:	4664 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4664 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:	614-487-7805
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTEN WILCOCK
Credential	:	BCBA
Telephone Number	:	614-557-9557

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “OHIO AUTISM TREATMENT LLC ” Practice Location

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